Ch 51: Nursing Care of a Family when a Child has a Musculoskeletal Disorder

a) Bracing Pg. 1451 For spinal curvatures of 25 to 40 degrees, the usual treatment is bracing. Curvatures greater than 40 degrees may be treated with traction or spinal instrumentation and fusion. Exercise may be implemented for very mild curvatures to strengthen the back muscles.

1. A 12-year-old female client has been diagnosed with scoliosis with a curvature of 30 degrees. What type of treatment would the nurse anticipate being started on this client? a) Bracing b) Exercise c) Surgery d) Traction

b) A muscle biopsy Pg. 1459 A decrease in muscle fibers, which is seen in a muscle biopsy, can confirm the diagnosis of muscular dystrophy.

13. The nurse is caring for a child with a possible diagnosis of muscular dystrophy. The nurse explains to the parents that which of the following will likely be used to confirm this child's diagnosis? a) Complete blood count b) A muscle biopsy c) A surgical consult d) An x-ray

d) Cartilage Pg. 1436 During fetal life, tissue called cartilage, which is a type of connective tissue consisting of cells implanted in a gel-like substance, gradually calcifies and becomes bone.

23. In understanding the development of the musculoskeletal system, the nurse recognizes that what is implanted in a gel-like substance during fetal life? a) Joints b) Tendons c) Ligaments d) Cartilage

c) "The window allows us to assess bowel sounds and helps to prevent abdominal distention" Pg. 1438 A window in placed over the abdomen in a body or hip spica cast to prevent abdominal distention and allow bowel sounds to be assessed. The window in a spica cast does not prevent compartment syndrome from happening.

26. The nurse is caring for a child who has a hip spica cast. The child's mother asks why is there a hole cut in it. What is the best response by the nurse? a) "The window helps to prevent a complication called compartment syndrome from happening" b) "The hole is called a window. It allows us to assess the incision on the hip" c) "The window allows us to assess bowel sounds and helps to prevent abdominal distention" d) "The hole is called a window. They put them in areas where the hard cast isn't needed"

b) "Her arm isn't broken. This injury is common and easily fixed with no complications" Pg. 1462 The nurse should quickly reassure the mother that this is a common occurrence, seen every day in the emergency department, and is easily fixed and resolves with no complications. Although a popping noise indicates entrapment of the ligament, this response does not address the mother's concerns. Although the radial head most likely dislocated, this response does not address the mother's concern. Although this condition is called nursemaid's elbow, telling the mother she has to be more careful only serves to put blame on the mother and does not address her concerns.

38. The emergency department nurse is caring for a 3-year-old girl with an arm injury. The mother is very upset because she believes she broke her daughter's arm. "I was lifting her by her hands and felt a pop in her wrist. She instantly started screaming." The child is now guarding and refusing to move her arm. Which response by the nurse would be most appropriate? a) "The popping noise was the ligament surrounding the radial head becoming entrapped" b) "Her arm isn't broken. This injury is common and easily fixed with no complications" c) "This is most likely nursemaid's elbow; you will have to be more careful in the future" d) "You probably dislocated her radial head when you lifted her"

d) "Let's review some of the instructions. She does need to take an anti-inflammatory every day" Pg. 1456 Teach family caregivers the importance of regular administration of the medications, even when the child is not experiencing pain. The primary purpose of aspirin or NSAIDs is not to relieve pain but to decrease joint inflammation.

39. The nurse is caring for a child diagnosed 3 months ago with juvenile idiopathic arthritis (JIA). The caregiver states that the child has recently reported little pain and is not currently taking aspirin or NSAIDs. The caregiver also tells the nurse that just to be on the safe side, she is continuing to keep the child from doing physical exercise. The mother states, "I think we have beaten this disease." In working with this child and the caregiver, which statement would be best for the nurse to make? a) "I'm glad you're feeling optimistic. She should exercise now but give her aspirin before she does" b) "It sounds as though things are going well. Be sure to restart the medication as soon as there is any flare-up of pain" c) "That is not what is best. The medications aren't for pain; she needs to take aspirin every few days" d) "Let's review some of the instructions. She does need to take an anti-inflammatory every day"

c) Paresthesia Pg. 1439 Paresthesia is diminished or absent sensation or numbness or tingling. Pallor is paleness of color and paralysis is the loss of function.

28. The nurse is doing neurovascular checks on a child who has had a cast applied to treat a fracture. The nurse observes for diminished or absent sensation and numbness or tingling. In doing this the nurse is monitoring for which symptom? a) Paralysis b) Pallor c) Paresthesia d) Pain

a) 40 degrees Pg. 1451 Nonsurgical treatment is attempted first for spinal curvatures less than 40 degrees.

34. A child and mother come into the orthopedic clinic. The mother is concerned about her child who has recently been diagnosed with scoliosis. The mother asks about surgical treatment and if it will be necessary. The nurse bases her response on knowledge that surgery is implicated for curvatures greater than: a) 40 degrees b) 25 degrees c) 25 to 30 degrees d) 20 to 25 degrees

b) Halo traction Pg.

43. A type of traction sometimes used in the treatment of the child with scoliosis is called: a) Dunlop traction b) Halo traction c) Bryant traction d) Russell traction

d) Complete Pg. 1460 If the fragments of fractured bone are separated, the fracture is said to be complete. If fragments remain partially joined, the fracture is termed incomplete. Greenstick fractures are one kind of incomplete fracture, caused by incomplete ossification, common in children. Spiral fractures twist around the bone.

3. The nurse is working with a group of caregivers of school-aged children discussing fractures. The nurse explains that if the fragments of fractured bone are separated, the fracture is said to be: a) Incomplete b) Greenstick c) Spiral d) Complete

b) A 13-year-old boy who is on his school's cross-country team Pg. 1447 Osgood-Schlatter disease is the thickening and enlargement of the tibial tuberosity resulting from microtrauma, probably caused from overuse. It occurs more often in boys than girls and at preadolescence or early adolescence, probably because of rapid growth at these times.

35. A nurse is working with a child who has Osgood-Schlatter disease. Which client would be the most likely to develop this condition? a) An 11-year-old girl who is obese b) A 13-year-old boy who is on his school's cross-country team c) A 9-year-old boy who is sedentary d) A 15-year-old girl who dances ballet

c) Unhooking a weight while providing pin care Pg. 1443 Weights should never be moved or unhooked during skeletal traction. Pin care is a sterile procedure. Pins are cleaned with half-strength hydrogen peroxide and then typically covered with sterile cotton gauze.

27. The charge nurse is observing a student nurse perform skeletal traction pin care. What action by the student nurse would indicate a need for intervention by the charge nurse? a) Using latex free sterile gloves b) Placing sterile cotton gauze squares around the ends of the pins c) Unhooking a weight while providing pin care d) Mixing hydrogen peroxide with sterile water to make half-strength hydrogen peroxide

b) Epiphysis Pg. 1436 Growth of the bones occurs primarily in the epiphyseal region. This area is vulnerable and structurally weak. Traumatic force applied to the epiphysis during injury may result in fracture in that area of the bone. The growth plate refers to the combination of the epiphysis, the end of a long bone, and the physis, a cartilaginous area between the epiphysis and the metaphysis.

40. A nurse is preparing a presentation for a parent group about musculoskeletal injuries. When describing a child's risk for this type of injury, the nurse integrates knowledge that bone growth occurs primarily in which area? a) Physis b) Epiphysis c) Growth plate d) Metaphysis

c) Gowers sign Pg. 1459 The child cannot rise easily to an upright position from a sitting or squatting position on the floor; instead, he or she develops Gowers sign, a method where the child rises from the floor by "walking up" the lower extremities with the hands.

6. The child diagnosed with muscular dystrophy uses a method of rising from the floor which is referred to as which of the following? a) Milwaukee brace b) Boston brace c) Gowers sign d) Legg-Calvé-Perthes

b) Minerals Pg. 1436 Minerals such as calcium, phosphorus, magnesium, and fluoride are stored in the bones.

10. In understanding the physiology of the musculoskeletal system, the nurse recognizes that which of the following are stored in the bones? a) Spinal fluid b) Minerals c) Vitamins d) Cartilage

c) Inflammation of the joints Pg. 1455 In the child with juvenile idiopathic arthritis, joint inflammation occurs first; if untreated, inflammation leads to irreversible changes in joint cartilage, ligaments, and menisci (the crescent-shaped fibrocartilage in the knee joints), eventually causing complete immobility.

15. The nurse is caring for a child admitted with juvenile idiopathic arthritis (JIA). Which clinical manifestation would likely have been noted in the child with this diagnosis? a) Poor posture and malformed vertebrae b) Difficulty standing and walking c) Inflammation of the joints d) Pain in the groin and a limp

a) Mild intellectual disability b) Progressive muscle weakness c) Difficulty rising from the floor Pg. 1459 Muscular dystrophy is a progressive X-lined recessive disease that results in increasing muscle weakness, lordosis, mild intellectual disability, and a shortened lifespan. Hip and groin pain is seen in patients with Legg-Calvé-Perthes disease.

19. A young boy is being evaluated for muscular dystrophy. What physical symptoms would be assessed for in this client? Select all that apply. a) Mild intellectual disability b) Progressive muscle weakness c) Difficulty rising from the floor d) Scoliosis e) Hip and groin pain

a) Blood work Pg. 1447-1448 In osteomyelitis, diagnosis is based on laboratory findings of leukocytosis (15,000 to 25,000 cells or more), an increased ESR, and positive blood cultures. Radiographic examination does not reveal the process until 5 to 10 days after the onset. A biopsy is not indicated with these symptoms.

41. The caregiver of a child with a recent puncture wound on the arm calls the pediatrician's office reporting that after seeming well at bedtime last night, the child now has a temperature of 101℉ (38.3℃), pain at the site of the injury, and is unable to fully bend the elbow of the arm which had been injured. The nurse recommends the child be brought in to see the health care provider. What would likely be ordered for this child? a) Blood work b) An x-ray c) A muscle biopsy d) A surgical consult

a) When on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand Pg. 1459 A Gower sign is when children "walk up their front." When on the floor, the only way they can stand is to roll on their stomach and push themselves up to their knees. They then press their hands against their ankles, knees, and thighs. The presence of a waddling gait, difficulty climbing stairs, and a short heel cord are all present in Duchenne muscular dystrophy, but they are not the Gower sign. Meeting milestones late is also a symptom of this disorder, but it is not the Gower sign.

12. The nurse is caring for a child diagnosed with Duchenne muscular dystrophy and notes the presence of a Gower sign on the assessment form. What action by the child would support this assessment? a) When on the floor, rising to the knees and pressing the hands against the ankles, knees, and thighs to stand b) Meeting motor milestones such as sitting, walking, and standing but at a later age than the average child c) The presence of a waddling gait and difficulty climbing stairs d) A short heel cord caused by walking on the toes

b) Staphylococcus aureus Pg. 1447 Staphylococcus aureus is the most common cause of osteomyelitis; therefore, the nurse would expect the antibiotics to cover that bacteria.

16. A child is admitted to the pediatric unit with osteomyelitis. The child is to be placed on antibiotics. The nurse expects antibiotic coverage to include which of the following as the most common cause of osteomyelitis? a) Haemophilus influenzae b) Staphylococcus aureus c) Mycobacterium d) Streptococcus group B

a) Spica cast Pg. 1438 The hip spica cast covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open. The cast maintains the legs in a frog-like position. Usually, there is a bar placed between the legs to help support the cast.

25. The nurse is discussing types of treatment used when working with children who have orthopedic disorders. Which form of treatment covers the lower part of the body, usually from the waist down, and either one or both legs while leaving the feet open? a) Spica cast b) Internal fixation device c) External fixation device d) Stockinette

a) Rotated and malformed vertebrae Pg. 1450 Structural scoliosis involves rotated and malformed vertebrae. Functional scoliosis can have several causes: poor posture, muscle spasm caused by trauma, or unequal length of legs.

7. The school nurse is doing a presentation to a group of caregivers of children diagnosed with scoliosis. One of the caregivers asks the nurse about structural scoliosis. Which condition is involved with the diagnosis of structural scoliosis? a) Rotated and malformed vertebrae b) Unequal leg length c) Poor posture d) Muscle spasm caused by trauma

a) Application of ice before and after athletic events c) Heel stretching exercises after the pain has subsided e) Addition of a lift or cup to the heel of the shoe of the affected size Pg. 1450 Sever disease (calcaneal apophysitis) is an overuse injury common in overweight children between ages 8 and 15 years. Treatment includes adding a lift or cup to the heal of the shoe, ice application before and after sporting events, NSAIDs such as ibuprofen, and once the pain has subsided, heel stretching exercises. Acetaminophen does not have anti-inflammatory properties and would not be indicated for this disorder. Immobilization and/or casting is not required.

8. The nurse is caring for an adolescent with Sever disease (calcaneal apophysitis). What treatment would be prescribed for this disorder? Select all that apply. a) Application of ice before and after athletic events b) Acetaminophen administration c) Heel stretching exercises after the pain has subsided d) Immobilization with a cast for 4 to 6 weeks e) Addition of a lift or cup to the heel of the shoe of the affected size

d) Feels increasing severe pain Pg. 1438 Any reports of pain in a child with a new cast or immobilized extremity need to be explored and monitored closely for the possibility of compartment syndrome.

11. The nurse caring for a child who has been put into a leg cast must be on the alert for signs of nerve and muscle damage. Which symptom might be an early warning signal that the child has developed compartment syndrome? The child: a) Has blue-looking nail beds on the toes b) Cannot plantar flex his foot c) Has a weak femoral pulse d) Feels increasing severe pain

c) Idiopathic scoliosis Pg. 1450 Idiopathic scoliosis is an S-shaped curvature of the spine. Kyphosis is an outward curvature of the cervical spine. Lordosis is an inward curving of the lumbar spine. Sway back is another term used for lordosis.

18. The nurse is assessing a child and notes S-shaped curvature of the spine. What terminology would the nurse use when documenting this assessment finding? a) Kyphosis b) Sway back c) Idiopathic scoliosis d) Lordosis

a) "Blowing cool air with a fan or hair dryer may relieve the feeling" Pg. 1439 Itching is a common report, but just stating this does not address the entire situation. The suggestion of blowing cool air is the best answer. Clients should never put anything in a cast to scratch. Lotion may be applied to the skin above or below a cast but should never be poured into a cast.

37. The nurse is speaking with the parents of a child who has a cast. The parents state that the child reports itching in the area of the cast. What is the best response by the nurse? a) "Blowing cool air with a fan or hair dryer may relieve the feeling" b) "Itching is common. It's nothing to worry about" c) "A small amount of lotion or baby oil can be poured in the cast to moisturize the area" d) "You can put a pencil or coat hanger and scratch the area but don't let your child put anything down the cast without you there"

d) Assessing the color and movement of the hand and fingers Pg. 1460 All of the options are correct nursing actions when the client returns from surgery following comminuted fracture; however, one is most important. Following surgery and external appliance stabilization, it is most important to complete a neurologic assessment checking for circulation sensation and motion. This is a priority as disruption in circulation can cause permanent tissue damage. After the check for sensation and motion, the nurse would assist the child to the bathroom, place the arm on a pillow to decrease edema, and assess for pain.

4. The nurse is planning care for a 14-year-old client whose x-ray shows a comminuted fracture with the need for external appliance stabilization. Which nursing action is most important? a) Using the 0-10 pain scale for pain level in the arm b) Placing the child in the bed and arm on a pillow c) Assisting the child to the bathroom to void d) Assessing the color and movement of the hand and fingers

b) "Because our child is being treated by using braces, the braces will have to be worn almost all the time" Pg. 1452 The Boston or the thoracolumbosacral orthosis (TLSO) brace is made of plastic and is customized to fit the child for treatment of scoliosis. The brace should be worn constantly, except during bathing or swimming, to achieve the greatest benefit. Halo traction may be used to treat clients with severe scoliosis, but not all clients. Children will be reassessed every 4 to 6 months to determine the prognosis for continuing brace therapy and potentially refitting. Bracing may be indicated for months or years. Surgery may be indicated, depending on the severity and complications resulting from the scoliosis; however, surgery is not the best option for all clients.

14. The nurse is discussing treatment for a child diagnosed with scoliosis. Which statement indicates the parents understand the nurse's education? a) "Because our child has scoliosis, treatment will include halo traction" b) "Because our child is being treated by using braces, the braces will have to be worn almost all the time" c) "The treatment for our child's scoliosis is anticipated to last between 3 to 4 months" d) "The most successful treatment for scoliosis is surgery before reaching adult age"

a) Administration of intravenous antibiotic therapy Pg. For osteomyelitis, the priority is to eradicate the infection by administering intravenous antibiotic therapy, initiated in the hospital and then continued at home for as long as 2 weeks; an intermittent infusion device or peripherally inserted central catheter (PICC) may be used. After this, the child will be prescribed an oral antibiotic for 3 to 4 more weeks. Immobilization would be important; however, there is no indication of the need for crutches. Although bed rest is warranted, a full body cast is unlikely. The child is not at risk for fluid overload so fluid restriction would be inappropriate.

17. A toddler is diagnosed with osteomyelitis. When developing the child's plan of care, which intervention would the nurse include? a) Administration of intravenous antibiotic therapy b) Maintenance of bed rest with a full body cast c) Implementation of fluid restriction d) Instructions for using crutches

a) Black race b) Obesity Pg. 1447 Risk factors associated with slipped capital femoral epiphysis include age between 9 and 16 years, black race, sedentary lifestyle, and being overweight or obese. A history of cystic fibrosis may contribute to rickets.

31. When assessing a child for slipped capital femoral epiphysis, what would the nurse identify as possible risk factors? Select all that apply. a) Black race b) Obesity c) Age younger than 8 years d) Excessive activity e) History of cystic fibrosis

c) "You are doing a great job. Let's put our heads together on how to keep her busy" Pg. 1436 The nurse should support the parents by encouraging and praising their compliance with bracing. It is also important to work with the parents to help develop age-appropriate diversions to promote normal growth and development. Telling the parents that they must be compliant or their daughter could develop severe bowing does not teach, does not offer solutions, and does not address the parents' concerns. Telling the parents that they must simply accept this and that the treatment could take years is likely to upset them and does not teach. It also does not address their concerns.

42. The nurse is caring for a 2-year-old girl in a bilateral brace with tibia vara. Her parents are upset by their toddler's limited mobility. Which response by the nurse would be most appropriate? a) "You'll need to accept this since treatment may be required for several years" b) "It's important to use the brace or your daughter may need surgery" c) "You are doing a great job. Let's put our heads together on how to keep her busy" d) "If you don't follow the therapy, your daughter could develop severe bowing of her legs"

b) A child's bones heal more quickly than those of an adult Pg. 1459 Bone healing in children occurs in the same fashion as in the adult, but it occurs more quickly in children because of the rich nutrient supply to the periosteum. The closer a fracture is to the growth plate, the more quickly the fracture heals. The capacity for remodeling (the process of breaking down and forming new bone) is increased in children compared with adults. Children's bones produce callus more rapidly and in larger quantities than do adults' bones.

5. A group of students is reviewing information about bone healing in children. The students demonstrate understanding of this information when they state: a) Callus production is slower (but greater in amount) in children than in adults b) A child's bones heal more quickly than those of an adult c) The process of breaking down and forming new bone is decreased in children compared with adults d) A fracture closer to the growth plate heals much slower than one in the metaphysis

a) Capillary refill c) Pulse d) Color e) Sensation Pg. 1442 A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality of pulses. Vital signs are not a component of a neurovascular assessment.

9. The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). What information would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. a) Capillary refill b) Vital signs c) Pulse d) Color e) Sensation

a) Joints Pg. 1436 Bones are attached to each other by connecting links called joints, which allow for movement of the body parts. Skeletal muscles attach to the bones, with a moveable joint between them. Tendons and ligaments hold the muscles and bones together. Cartilage is a type of connective tissue consisting of cells implanted in a gel-like substance, which gradually calcifies and becomes bone.

2. In understanding the function of the musculoskeletal system, the nurse recognizes that which of the following allows for movement of the body parts? a) Joints b) Cartilage c) Tendons d) Ligaments

d) "This medication will cure my child of this disorder" Pg. 1446 Bisphosphonates are used in the palliative, not curative, treatment of osteogenesis imperfecta. The medication increases bone mineral density, therefore reducing the risk of the child developing fractures. The medication does not actually prevent fractures from happening.

20. The nurse has been teaching the parents of a child diagnosed with osteogenesis imperfecta about the use of bisphosphonates for this condition. What statement by a parent indicates a need for further education? a) "This medication doesn't prevent fractures from happening" b) "This medication will help to increase bone mineral density" c) "My child's risk for fractures will hopefully be decreased as by taking this medication" d) "This medication will cure my child of this disorder"

d) Impaired physical mobility related to a cast on the leg Pg. 1435 Impaired physical mobility would be the priority need for this client. Basic comfort, food, fluid, and other basic needs are considered a higher priority than diversional activities and self-esteem. Pain would be the normally be the highest priority in this list, but this client would have acute inflammation rather than chronic inflammation.

21. The student nurse is developing a care plan for a child who suffered a fractured tibia and will have a cast on his lower leg for approximately 6 weeks. Which nursing diagnosis would be the priority for this client? a) Pain related to chronic inflammation of the lower leg b) Situational low self-esteem related to the use of a walker c) Deficient diversional activities related to a need for imposed activity restriction for 6 weeks d) Impaired physical mobility related to a cast on the leg

c) A young child's bones commonly bend instead of break when an injury occurs Pg. 1459 The infant and a young child's bones are more flexible and more porous with a lower mineral count than adults. The structural differences of a young child's bone allow for greater shock absorption thus, bones will often bend rather than break when an injury occurs. Growth plates are growing tissue found near the ends of long bones. The infant's skeleton is not fully ossified at birth. Children's bones have a thick periosteum and an abundant blood supply.

22. When teaching a group of parents about the skeletal development in children, what information will the nurse provide? a) The growth plate is the area of growing tissue near the ends of flat bones b) The infant's skeleton has undergone complete ossification by birth c) A young child's bones commonly bend instead of break when an injury occurs d) Children's bones have a thin periosteum and limited blood supply

c) "My mom is going to have to pick up all of her throw rugs so I don't slip on them" Pg. 1441 Throw rugs, small footstools, and toys need to be cleared out of paths at home so the crutches do not slip. Children should not rest their axilla on the crutch pads when standing; this can cause damage to the brachial nerve plexus. When the child is walking, crutches need to be approximately 6 inches (15 cm) to the side of the foot to maintain a wide, balanced base for support. It is okay to utilize a backpack to carry books and supplies because the client's hands will not be free due to the crutches.

24. A nurse is performing crutch training for an adolescent who has a fractured tibia. What statement by the adolescent indicates successful teaching? a) "I'm going to need a friend to carry by books at school. I can't use a backpack because it may throw me off balance." b) "I will make sure to rest my axilla on the crutches when I am standing so I can rest my hands and wrists" c) "My mom is going to have to pick up all of her throw rugs so I don't slip on them" d) "When I'm walking with my crutches, the crutches need to be at least 12 inches (30.5 cm) from the side of my feet"

a) Check the infant's toes for coldness or blueness Pg. 1438 Review with parents how to check the infant's toes for coldness or blueness and how to blanch a toenail bed and watch it turn pink to assess for good circulation. The other answers are other interventions pertaining to caring for a child with clubfoot but are not associated specifically with ensuring good circulation.

29. A child is born with clubfoot (congenital talipes equinovarus). The child later receives a cast on the affected leg to correct the problem. Which measure should the nurse mention to the mother to ensure good circulation in the affected leg? a) Check the infant's toes for coldness or blueness b) Apply Denis Browne splints to the infant each night c) Perform passive foot exercises d) Change the infant's diapers frequently

c) Significant bending without actual breaking Pg. 1460 A plastic or bowing deformity is one in which there is significant bending of the bone without breaking. A buckle fracture is one in which the bone buckles rather than breaks. This is usually due to a compression injury. An incomplete fracture of the bone is a greenstick fracture. A complete fracture is one in which the bone breaks into two pieces.

30. A nurse is reviewing the medical record of a child who has sustained a fracture. Documentation reveals a bowing deformity. The nurse interprets this fracture as: a) Incomplete fracture b) Bone buckling due to compression c) Significant bending without actual breaking d) Bone that breaks into two pieces

c) Osteomyelitis Pg. 1447 Osteomyelitis is a bone infection usually caused by Staphylococcus aureus, which causes leg pain and fever. Lab work reflects an elevated leukocyte count and an increased erythrocyte sedimentation rate. X-rays look normal until 5 to 10 days after onset of symptoms.

32. A nurse assesses a client who is reporting calf pain and a very sore leg. The client has a temperature of 101°F (38.3°C). X-rays do not reveal any abnormalities but the client's white count is 21,000 cells and the erythrocyte sedimentation rate is elevated. What condition do these symptoms suggest? a) Compartment syndrome b) Legg-Calvé-Perthes disease c) Osteomyelitis d) Muscular dystrophy

d) Ask the parent, "What are your child's favorite activities?" Pg. 1456 Because the parent is fearful, the nurse's best course of action is to determine the child's favorite activities and address each one specifically to determine if any modifications are required. This action eliminates any vague concerns and addresses the needs of the child with input from both parent and child. The parent might interpret the instruction to avoid gymnastics and high-impact sports to include the child's favorite activities. Telling the parent that activity is encouraged for children with JA may be interpreted as overruling personal decisions. That may disrupt therapeutic communication.

33. A 12-year-old child has been recently diagnosed with juvenile arthritis (JA). The child is eager to resume physical activity but the parent is very concerned about the child's safety and has completely limited the child's activities. Which is the best way to address the parent's concerns and encourage activity? a) State to the parent, "Activity is encouraged for children with JA" b) Address both by stating, "High-impact sports are not recommended" c) Agree with the parent, "Your child needs to avoid gymnastics" d) Ask the parent, "What are your child's favorite activities?"

a) "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet" Pg. 1445 When a parent describes a child as always falling over the feet or awkward, the nurse needs to assess for toeing-in or metatarsus adductus. One way to assess for this is to have the child stand on a copier and make a print of the feet. It will show any inward turning of the feet. For most instances, it resolves without therapy. If it persists past 1 year, passive stretching exercises may be prescribed. It is not a severe bone disorder and typically does not need surgical intervention.

36. The nurse is assessing a toddler. The mother states that he constantly is tripping over his own feet. What is the best response by the nurse? a) "We will have your child stand on a copier and make a print of the feet. It will show us if the feet are turning in. If they are, your child may need some stretching exercises for the feet" b) "Tripping over feet is a symptom of a severe bone disorder, metatarsus adductus. We will need to refer you to an orthopedic surgeon" c) "Turning in of feet or toeing in, is common at this age. As your child keeps walking, it will correct on its own" d) "At this age, your child is still learning how to control all of the muscles in the legs. As your child grows older, this clumsiness will get better"